Competact

Competact is a fixed-dose combination tablet containing pioglitazone and metformin hydrochloride, used in the management of type 2 diabetes mellitus.

It is prescribed for patients whose blood glucose is inadequately controlled on metformin alone and who are considered suitable for the addition of a thiazolidinedione.

Pioglitazone is an insulin sensitiser that acts on peroxisome proliferator-activated receptor-gamma (PPAR-gamma), improving the body's response to its own insulin in muscle, fat, and liver tissue.

This reduces insulin resistance, a central feature of type 2 diabetes. Metformin complements this action by reducing hepatic glucose output and improving peripheral glucose uptake.

The combination of these two agents in a single tablet simplifies the treatment regimen and may improve adherence compared with taking two separate medications.

Competact does not stimulate insulin secretion directly and therefore carries a low intrinsic risk of hypoglycaemia when used without sulphonylureas or insulin.

Competact is intended for use alongside a programme of diet control, exercise, and weight management. It does not replace lifestyle interventions but augments their effect on glycaemic control.

Take one tablet twice daily with or shortly after meals to reduce gastrointestinal discomfort from the metformin component. Swallow the tablet whole with water.

Continue taking Competact as prescribed, even if you feel well, since hyperglycaemia is often asymptomatic.

Monitor your blood glucose regularly as advised by your diabetes team. Report any unexpected weight gain, ankle swelling, or breathlessness to your prescriber, as these may indicate fluid retention.

Do not stop taking Competact without medical advice. If you miss a dose, take it as soon as you remember with your next meal, but do not double up to make up for a missed dose.

Competact is available as 15 mg/850 mg tablets (pioglitazone/metformin). The usual dose is one tablet twice daily.

The maximum daily dose of pioglitazone is 30 mg and the maximum daily metformin is 1,700 mg with this combination.

Dosing should be individualised based on the patient's current metformin dose. Renal function should be assessed before starting and at least annually.

Competact is not suitable for patients with an eGFR below 30 mL/min.

Weight gain is common with pioglitazone and may amount to 2 to 4 kg over the first year of treatment.

Fluid retention manifesting as peripheral oedema (swollen ankles) occurs in approximately 5 to 10 per cent of patients and is more common when pioglitazone is combined with insulin.

Metformin-related gastrointestinal effects include nausea, diarrhoea, abdominal discomfort, and a metallic taste. These usually settle with continued use and gradual dose titration.

Pioglitazone is associated with a small increased risk of bone fractures, particularly in women.

An increased incidence of bladder cancer has been reported in epidemiological studies, though the absolute risk is low.

Rarely, lactic acidosis may occur due to the metformin component, particularly in the setting of renal impairment, dehydration, or excessive alcohol intake.

Liver function abnormalities have been reported with pioglitazone.

Do not use Competact if you have heart failure or a history of heart failure (NYHA class I to IV), as pioglitazone may cause or exacerbate fluid retention.

Seek medical attention if you develop breathlessness, rapid weight gain, or ankle swelling.

Pioglitazone should not be used in patients with active or a history of bladder cancer, or uninvestigated macroscopic haematuria.

Liver function tests should be performed before starting treatment and periodically thereafter.

Temporarily discontinue Competact before procedures involving iodinated contrast media and during intercurrent illness causing dehydration, to reduce the risk of lactic acidosis.

Competact is contraindicated in patients with heart failure (any NYHA class), diabetic ketoacidosis, hepatic impairment, severe renal impairment (eGFR below 30 mL/min), active or previous bladder cancer, and known hypersensitivity to pioglitazone, metformin, or any excipient.

It should not be used in type 1 diabetes.

Lactic acidosis is a rare but serious contraindication related to the metformin component, particularly in the context of renal failure, sepsis, or tissue hypoxia.